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Hospice Care

    Compounded Services

Overview of Compounding in Hospice Care

TIB Pharmacy is a name synonymous with high-quality hospice pharmacy services in the Bay Area and Central Valley of California. With years of dedicated service to hospice clients, TIB Pharmacy has established a deep understanding of the unique needs and challenges faced by hospice care providers. In hospice care, compounding plays a critical role in managing symptoms, improving comfort, and enhancing the quality of life for patients in the final stages of a terminal illness. The compounding process allows pharmacists to prepare medications in specific dosages, forms, and combinations that are not commercially available. This is particularly important for hospice patients, as their conditions may require very precise medication adjustments. Custom compounding can include changes in dosage strength, flavoring to make medications easier to take, or providing medications in forms like suppositories, transdermal creams, or liquid doses that are more appropriate for a patient who has difficulty swallowing pills.

Benefits of Compounding in Hospice

  • 1.
    Personalization:Medications can be customized for the patient’s unique needs, including dose adjustments, liquid formulations for patients who have trouble swallowing pills, and combinations of drugs that work better together.
  • 2.
    Symptom Management:In hospice care, the goal is to alleviate pain and improve the quality of life. Compounding helps create medications that target specific symptoms such as pain, nausea, anxiety, or breathing difficulties.
  • 3.
    Improved Compliance:Some patients may refuse or struggle with taking conventional medications. Compounding can help provide medication in a form that is more acceptable, such as flavored solutions, topical creams.
  • 4.
    Alternative Delivery Systems:For patients with swallowing issues, compounded medications can be made in liquid or transdermal forms. Other formulations include suppositories, gels, or lozenges.
  • 5.
    Pain Control:As hospice patients often experience pain, compounding allows for medications that provide targeted pain relief, such as creams or topical treatments that deliver analgesics directly to the area of pain.

Common Medications Used in Hospice Compounding

Acetaminophen 250mg/ml

The cream is designed to provide localized pain relief, particularly for conditions that affect the muscles, joints, or skin. It can be an alternative for people who cannot take oral pain medications due to gastrointestinal issues or other medical concerns.

Uses of Acetaminophen Compounded Cream

Acetaminophen compounded cream is used for the relief of localized pain and discomfort. Some common uses include:

  • ●
    Musculoskeletal Pain:It can help relieve pain from conditions like arthritis, muscle strains, sprains, or tendonitis.
  • ●
    Joint Pain:Used to alleviate discomfort from conditions such as osteoarthritis or joint injuries.
  • ●
    Post-Surgical Pain:It may be applied to areas affected by surgery, particularly where pain is concentrated in specific regions, to help reduce discomfort.
  • ●
    Neuropathic Pain:Some individuals with nerve-related pain, like peripheral neuropathy, may benefit from its pain-relieving properties.

The cream is dispensed in a pump and delivers acetaminophen directly to the affected area, allowing for targeted pain relief without the systemic side effects associated with oral medications.

Side Effects of Acetaminophen Compounded Cream

While acetaminophen is generally considered safe when used appropriately, the topical form can still cause some side effects, although they are usually less severe than those associated with oral acetaminophen. Common side effects include:

  • ●
    Skin Irritation:Redness, itching, or a rash at the site of application may occur.
  • ●
    Allergic Reaction:Some individuals may experience a more serious allergic reaction, including swelling, difficulty breathing, or hives. If this happens, immediate medical attention is required.
  • ●
    Contact Dermatitis:Prolonged use or use in sensitive areas may result in inflammation or dermatitis.
  • ●
    Absorption Issues:While rare, excessive use of the cream or applying it over large areas of skin may lead to a higher absorption of acetaminophen into the bloodstream, potentially causing toxicity. This can be avoided by following proper usage instructions.
  • ●
    Overuse Risk:Since it is a compounded product, users should be cautious not to use more than recommended, as misuse may lead to unwanted side effects or overdose. Even though it's topical, it's still important to avoid exceeding the safe dosage of acetaminophen.

How often should I apply it?

Follow your healthcare provider's instructions on frequency. Do not exceed the recommended dosage.

As with any medication, it's important to consult with a healthcare provider before using acetaminophen compounded cream, especially for those with underlying medical conditions or when using other medications.

Lorazepam 1mg/ml / Haloperidol 2mg/ml Compounded Formulation

The Lorazepam 1mg/ml and Haloperidol 2mg/ml compounded formulation is a combination of two medications used for managing various psychiatric and behavioral conditions. Compounded medications like this one are typically prepared in a pharmacy to meet specific patient needs when commercially available options do not fit. Lorazepam is a benzodiazepine, and Haloperidol is an antipsychotic. When combined in a compounded formulation, they can work synergistically to address symptoms of anxiety, agitation, and other mental health concerns.

The compounded version allows for more tailored dosing and delivery, particularly in situations where patients may require a specialized dosage not available in standard products.

Uses of Lorazepam 1mg/ml / Haloperidol 2mg/ml Compounded Formulation

This compounded medication is commonly used in the following situations:

  • ●
    Acute Agitation:It can help reduce severe agitation in patients with psychiatric disorders.
  • ●
    Severe Anxiety:The lorazepam component helps alleviate anxiety, while haloperidol helps manage agitation or psychosis that may accompany intense anxiety.
  • ●
    Psychotic Disorders:This combination is sometimes used to control symptoms of psychosis, especially when rapid sedation or calming effects are necessary.
  • ●
    Preoperative Sedation:Sometimes prescribed to calm patients prior to surgery or other procedures, especially in anxious or agitated individuals.
  • ●
    Behavioral Disorders:Used in patients with conditions such as schizophrenia or bipolar disorder, where managing both psychotic symptoms and anxiety is essential.

The formulation's benefits come from the synergistic effects of lorazepam's calming properties and haloperidol's ability to control psychotic symptoms and agitation.

Side Effects of Lorazepam 1mg/ml / Haloperidol 2mg/ml Compounded Formulation

While effective, this compounded medication can cause side effects. These side effects are typically associated with the individual medications but may be more pronounced when used together. Common side effects include:

  • ●
    Sedation and Drowsiness:Both lorazepam and haloperidol can cause significant sedation. This may be useful for calming agitation but may result in excessive drowsiness or sleepiness, particularly when starting the medication.
  • ●
    Dizziness and Lightheadedness:These medications can lower blood pressure, leading to dizziness, especially when standing up quickly.
  • ●
    Extrapyramidal Symptoms (EPS):Haloperidol, an antipsychotic, can cause movement-related side effects such as tremors, muscle stiffness, restlessness, or tardive dyskinesia (involuntary movements). These effects are more likely with higher doses or prolonged use.
  • ●
    Cognitive Impairment:Both medications may cause memory problems, confusion, or difficulty concentrating, especially in older adults or those on high doses.
  • ●
    Respiratory Depression:Lorazepam can depress the respiratory system, particularly if combined with other sedative medications or taken in higher doses. Close monitoring is required.
  • ●
    Allergic Reactions:Rare, but some individuals may experience allergic reactions, including swelling, rash, or breathing difficulties, requiring immediate medical attention.
  • ●
    Tolerance and Dependence:Lorazepam, as a benzodiazepine, carries a risk of tolerance (requiring more of the medication for the same effect) and dependence (becoming reliant on the medication).

Given the potential for significant side effects, this compounded formulation should only be used under medical supervision. Patient's should be monitored closely, especially for any signs of sedation, cognitive changes, or movement disorders.

As with any medication, it's important to consult with a healthcare provider before using compounded cream, especially for those with underlying medical conditions or when using other medications.

LORAZEPAM 1 MG/ML (Lorazepam Compounded Cream)

Lorazepam 1mg/ml is a compounded cream formulation of lorazepam, a benzodiazepine that acts as a sedative, anxiolytic (anxiety-reducing), and anticonvulsant. Lorazepam is commonly prescribed for conditions involving anxiety, sleep disorders, and seizure management.

Uses of Lorazepam 1mg/ml

  • ●
    Anxiety Disorders:Lorazepam helps to reduce the symptoms of anxiety, including nervousness, agitation, and restlessness.
  • ●
    Sleep Disorders:It is used to manage insomnia related to anxiety or stress by helping to induce sleep.
  • ●
    Seizure Disorders:Lorazepam can be used to manage seizures, particularly acute seizures or those associated with alcohol withdrawal.
  • ●
    Preoperative Sedation:It can also be used before surgeries or medical procedures to calm patients and reduce anxiety.

Side Effects of Lorazepam 1mg/ml

  • ●
    Drowsiness:Lorazepam can cause sedation, leading to drowsiness and impaired alertness.
  • ●
    Dizziness:This medication can cause dizziness or lightheadedness, especially when standing up quickly.
  • ●
    Cognitive Impairment:Memory loss, confusion, or difficulty concentrating may occur, particularly with long-term use.
  • ●
    Dependence and Tolerance:Prolonged use of lorazepam can lead to physical dependence and tolerance, meaning higher doses may be required over time.
  • ●
    Respiratory Depression:Overuse or misuse, especially when combined with other depressants, can cause serious respiratory depression.
  • ●
    Allergic Reactions:Rarely, lorazepam can cause allergic reactions like rash, swelling, or difficulty breathing, which requires immediate medical attention.

The compounded formulations must be used carefully, under medical supervision, and with attention to the patient's medical history and current medications.